Provider Demographics
NPI:1558573824
Name:FRIEDMAN, MIRON (DC)
Entity Type:Individual
Prefix:DR
First Name:MIRON
Middle Name:
Last Name:FRIEDMAN
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:95 CLIFTWOOD DR NE
Mailing Address - Street 2:SUITE A
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30328-4839
Mailing Address - Country:US
Mailing Address - Phone:404-257-9989
Mailing Address - Fax:404-257-9962
Practice Address - Street 1:95 CLIFTWOOD DR NE
Practice Address - Street 2:SUITE A
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30328-4839
Practice Address - Country:US
Practice Address - Phone:404-257-9989
Practice Address - Fax:404-257-9962
Is Sole Proprietor?:No
Enumeration Date:2007-05-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIR006894111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA35ZCGXCMedicare ID - Type Unspecified
GAU90981Medicare UPIN